Minerva anestesiologica
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The recent onset of orthogonal polarization spectral (OPS) imaging techniques has allowed the direct visualization of the microcirculation at the bedside of critically ill patients. A systematic review with particular emphasis on recent findings and implications in pathophysiological processes is presented. Using OPS techniques various investigators have observed microcirculatory alterations in critically ill patients, and especially in patients with severe sepsis and septic shock. ⋯ Microcirculation plays an important role in the pathogenesis of shock and organ dysfunction, especially in sepsis. The microcirculatory effects of various therapeutic interventions have still to be reported. OPS technique may become a valuable tool to monitor patients with circulatory failure.
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The recent onset of orthogonal polarization spectral (OPS) imaging techniques has allowed the direct visualization of the microcirculation at the bedside of critically ill patients. A systematic review with particular emphasis on recent findings and implications in pathophysiological processes is presented. Using OPS techniques various investigators have observed microcirculatory alterations in critically ill patients, and especially in patients with severe sepsis and septic shock. ⋯ Microcirculation plays an important role in the pathogenesis of shock and organ dysfunction, especially in sepsis. The microcirculatory effects of various therapeutic interventions have still to be reported. OPS technique may become a valuable tool to monitor patients with circulatory failure.
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Minerva anestesiologica · Apr 2006
ReviewInterfacing spontaneous breathing and mechanical ventilation. New insights.
Mechanical ventilation (MV) with positive pressure insufflations of gas into the lung may be required to ensure sufficient oxygenation of blood and elimination of carbon dioxide in acute respiratory failure. Interfacing spontaneous breathing and mechanical ventilation has been used to improve gas exchange and may offer other advantages regarding integrity of lung tissue. Airway pressure release ventilation (APRV), or bilevel positive airway pressure (BiPAP), is a mechanical ventilatory mode with a low respiratory rate upon which spontaneous breaths can be superimposed during any time of the respiratory cycle. ⋯ Since blood flow goes preferentially to the dependent regions, the altered ventilation distribution results in improved matching of ventilation and perfusion, further enhancing or facilitating gas exchange. Moreover, there is less cyclic collapse, i.e. less re-collapse during expiration and reopening during inspiration than with MV alone. Further development of the interfacing technique can be expected, with synchronization and also dosing of the mechanical support and with triggering of the ventilator that is based on neural recordings rather than mechanical signals as pressure and flow.